Expense Reimbursement – Blacks In Technology Foundation

Complete the form if you wish to be reimbursed for chapter related expenses.

Mailed checks estimated deliver timeframe is 10-14 days.

Wire transfer estimated deliver timeframe is 4-7 days.

BIT Expense Reimbursement

Full Name

Preferred Email

Chapter

Reimbursement Amount

Expense Reason

Expense Date

Reimbursement Amount

Expense Reason

Expense Date

Reimbursement Amount

Expense Reason

Expense Date

Reimbursement Amount

Expense Reason

Expense Date

Reimbursement Amount

Expense Reason

Expense Date

Total Amount to Be Reimbursed

Currency

Receipts

Maximum upload size: 268.44MB

Reimbursement Type

Mailed Check

Electronic Wire Transfer

Zelle

Bank Name

Name on Account

Account Number

Routing Number

Zelle Phone #

Zelle Email

Name

Address

Address Cont.

City

State/Province

Zip/Postal

BIT Chapter Expense Reimbursement